Histopathological insights into treatment failure with the levonorgestrel releasing intrauterine system in women with heavy menstrual bleeding: a retrospective study

Saroj Kumari, Nigamananda Mishra, Siddhi A Kode
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(2) , pp. 579–582 · doi:10.18203/2320-1770.ijrcog20260178 · W7126079714
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This retrospective study of 88 women found that levonorgestrel-releasing intrauterine system treatment failure for heavy menstrual bleeding was primarily associated with underlying uterine pathologies, especially adenomyosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This retrospective study (BARC Hospital, Mumbai; Jan 2017–Mar 2020) evaluated 88 women with heavy menstrual bleeding treated with a levonorgestrel-releasing intrauterine system (LNG-IUS), identifying non-responders as those with persistent heavy bleeding and examining endometrial biopsy and, in some cases, hysterectomy specimens for histopathological correlates of treatment failure. Treatment failure occurred in 26 women (29.5%), and among biopsy findings, proliferative endometrium (65.4%), disordered proliferative endometrium (19.2%), and secretory endometrium (15.4%) were reported. Of nine hysterectomy specimens from non-responders, adenomyosis was most frequent (44.4%), followed by adenomyosis with leiomyoma (33.3%), endometrial polyp (11.1%), and leiomyoma (11.1%). The paper’s major caveat is its retrospective design and small number of hysterectomy-provided histology samples for non-responders. This paper is centrally about endometriosis and/or adenomyosis—specifically adenomyosis associated with histopathological findings in LNG-IUS treatment failure for heavy menstrual bleeding.

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Abstract

Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an established first-line therapy for heavy menstrual bleeding (HMB), effectively reducing menstrual blood loss and improving quality of life in most women. However, a subset of patients fails to achieve adequate response, warranting evaluation of potential underlying causes. Methods: This retrospective study was conducted at BARC Hospital, Mumbai, from January 2017 to March 2020, and included 88 women with HMB treated with LNG-IUS. Non-responders were identified based on persistent heavy bleeding despite therapy. Endometrial biopsy and, where applicable, hysterectomy specimens were analyzed to determine histopathological findings associated with treatment failure. Results: Of the 88 women treated, 26 (29.5%) were classified as non-responders. Endometrial biopsy revealed proliferative endometrium in 65.4%, disordered proliferative endometrium in 19.2%, and secretory endometrium in 15.4% of cases. Among nine non-responders who underwent hysterectomy, adenomyosis was the most common finding (44.4%), followed by adenomyosis with leiomyoma (33.3%), endometrial polyp (11.1%), and leiomyoma (11.1%). Conclusions: Treatment failure of LNG-IUS in women with HMB was predominantly associated with structural uterine abnormalities, particularly adenomyosis. Comprehensive pre-insertion evaluation, including clinical and imaging assessment, is essential to detect underlying pathology and optimize patient selection. Individualized management based on uterine morphology and symptom profile may improve therapeutic success and reduce delays in achieving symptom control.
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Background

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an established first-line therapy for heavy menstrual bleeding (HMB), effectively reducing menstrual blood loss and improving quality of life in most women. However, a subset of patients fails to achieve adequate response, warranting evaluation of potential underlying causes.

Methods

This retrospective study was conducted at BARC Hospital, Mumbai, from January 2017 to March 2020, and included 88 women with HMB treated with LNG-IUS. Non-responders were identified based on persistent heavy bleeding despite therapy. Endometrial biopsy and, where applicable, hysterectomy specimens were analyzed to determine histopathological findings associated with treatment failure.

Results

Of the 88 women treated, 26 (29.5%) were classified as non-responders. Endometrial biopsy revealed proliferative endometrium in 65.4%, disordered proliferative endometrium in 19.2%, and secretory endometrium in 15.4% of cases. Among nine non-responders who underwent hysterectomy, adenomyosis was the most common finding (44.4%), followed by adenomyosis with leiomyoma (33.3%), endometrial polyp (11.1%), and leiomyoma (11.1%).

Conclusions

Treatment failure of LNG-IUS in women with HMB was predominantly associated with structural uterine abnormalities, particularly adenomyosis. Comprehensive pre-insertion evaluation, including clinical and imaging assessment, is essential to detect underlying pathology and optimize patient selection. Individualized management based on uterine morphology and symptom profile may improve therapeutic success and reduce delays in achieving symptom control. Metrics

References

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